Provider Demographics
NPI:1801382932
Name:TINSLEY, RANDY EDWIN JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:EDWIN
Last Name:TINSLEY
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-8705
Mailing Address - Country:US
Mailing Address - Phone:870-291-1347
Mailing Address - Fax:
Practice Address - Street 1:275 CYPRESS CIR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-8705
Practice Address - Country:US
Practice Address - Phone:870-291-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist